Hip joint device and method

ABSTRACT

A medical device for implantation in a hip joint of a patient is provided. The medical device comprises a first and second piece and a releasing member adapted to, in a first state hold the first piece attached to the second piece, and in a second state release the first piece from the second piece. The releasing member is adapted to change from the first state to the second state when a pre-determined strain is placed on the releasing member.

TECHNICAL FIELD

The invention relates generally to hip joint prosthesis.

BACKGROUND

Hip joint Osteoarthritis is a syndrome in which low-grade inflammationresult in pain in the hip joints, caused by abnormal wearing of theCartilage that act as a cushion inside if the hip joint. This abnormalwearing of the cartilage also results in a decrease of the jointslubricating fluid called Synovial fluid. Hip joint Osteoarthritis isestimated to affect 80% of all people over 65 years of age, in more orless serious forms.

The present treatment for hip osteoarthritis comprises NSAID drugs,local injections of Hyaluronic acid or Glucocorticoid to helplubricating the hip joint, and replacing part of the hip joint with aprosthesis through hip joint surgery.

The replacing of part of the hip joint is one of the most commonsurgeries to date performed at hundreds of thousands of patients in theworld every year. The most common method comprises placing a metalprosthesis in Femur and a plastic bowl in Acetabulum. This operation isdone through an incision in the hip and upper thigh and through FasciaIata and the lateral muscles of the thigh. To get access to the joint,the supporting Fibrous Capsule attached to Femur and Ilium needs to bepenetrated, making it difficult to get a fully functional joint afterthe surgery. Femur is then cut at the neck with a bone saw and theprosthesis is placed in femur either with bone cement or withoutAcetabulum is slightly enlarged using an Acetabular reamer, and theplastic bowl is positioned using screws or bone cement.

The complications after hip joint surgery includes dislocation of thehip joint and loosening of the prosthesis from its fixation in thefemoral bone. The loosening and/or dislocation of the prosthesis couldbe induced by an abnormal strain being placed on the hip joint from e.g.the patient falling or making a rapid movement of the hip. A completelyfixed hip joint prosthesis, without the possibility to dislocate wouldincrease the risk of the prosthesis loosening from its fixation in thefemoral bone, since the entire strain is then placed on the femoralbone.

A hip joint prosthesis that could reduce the complications after hipjoint surgery would therefore be desirable.

SUMMARY

A medical device for implantation in a hip joint of a patient isprovided. The medical device comprises a first piece adapted to befixated to the pelvic bone. The first piece comprises a convexcontacting surface adapted to be partially placed inside a concavecontacting surface. The medical device further comprises a second pieceadapted to be fixated to the femoral bone. The second piece comprises aconcave contacting surface adapted to partially surround the convexcontacting surface of said first piece, when implanted. The medicaldevice further comprises a releasing member adapted to, in a firststate, hold the first piece attached to the second piece, and in asecond state release the first piece from the second piece. Thereleasing member is adapted to change from the first state to the secondstate when a pre-determined strain is placed on the releasing member.The construction with a releasing member reduces the risk of damagingany structures of the human body and/or interconnections between thehuman body and prosthetic part.

According to one embodiment of the medical device, the convex contactingsurface of the first and/or second piece is at least partiallyspherical.

According to another embodiment the concave contacting surface of thesecond piece is at least partially spherical.

The first piece could according to one embodiment comprise a ball shapedpiece, and the second piece could comprise a bowl shaped piece. The ballshaped piece could be adapted to be placed in the bowl shaped piece toreplace a functioning hip joint The ball shaped piece could be adaptedto be fixated in the bowl shaped piece using the releasing member.

The releasing member according to any of the embodiments herein could beadapted to non-invasively change from the first state to the secondstate and from the second state to the first state, when apre-determined strain is placed on the releasing member.

At least one of the first and second pieces comprises at least two partsadapted to be in contact with each other when the medical device isimplanted in the patient.

According to another embodiment the first or said second pieces areadapted to be introduced through a hole in the pelvic bone of thepatient. One of said at least two pieces could be adapted to bemechanically fixated to each other after the at least two pieces havebeen introduced into the hip joint through a hole in the pelvic bone ofthe patient.

The hole in the pelvic bone could have a cross sectional area smallerthan 530 mm2, smaller than 380 mm2, smaller than 250 mm2, smaller than180 mm2 or smaller than 110 mm2.

According to one embodiment, the second piece of the medical devicecomprises the releasing member according to any of the embodimentsherein. The releasing member could comprise an elastic portion, whichfor example could comprise an elastic material, a spring or an elasticband. The elastic band could be adapted to at least partly encircle saidball shaped piece.

According to another embodiment of the medical device, the releasingmember comprises at least one of bendable portion, a flexible portion, acompressible portion, a movable portion or a movable part.

According to yet another embodiment the releasing member comprises amagnet adapted to hold the first piece to the second piece.

According to yet another embodiment the releasing member comprises arupture device adapted to fail at a pre-determined strain. The rupturedevice could for example comprise a rupture band and/or a rupture pin.

The releasing member could according to one embodiment comprise multipleholding members, which in turn could be adapted to slide against thefirst piece, or roll against the first piece. According to oneembodiment the holding member adapted to roll comprises a ball shapedholding member.

The first piece of the medical device according to any one of theembodiments herein could comprise at least two parts adapted to be incontact with each other when the medical device is implanted in thepatient. One of the at least two parts could be adapted to bemechanically fixated to the second of the at least two parts after theat least two parts have been introduced into the hip joint through ahole in the pelvic bone of the patient.

The first piece could according to one embodiment comprise a flexibleportion or an elastic portion adapted to enable the medical device to beinserted through a hole in the pelvic bone, the elastic portion enablingthe compression of the first piece in at least one direction.

According to yet another embodiment the first piece comprises a firstarea and a second area. The first area comprises a first materialadapted to be elastic and the second area comprises a second materialadapted to be elastic. The first material could be adapted to be moreelastic than the second material.

According to one embodiment of the medical device the second piececomprises at least two parts adapted to be in contact with each otherwhen the medical device is implanted in the patient. One of the at leasttwo parts could be adapted to be mechanically fixated to a second of theat least two parts after the at least two parts have been introducedinto the hip joint through a hole in the pelvic bone of the patient.

The medical device could according to yet another embodiment comprise acalibration member for calibrating the pre-determined strain requiredfor the releasing member to change from the first state to said secondstate. The calibration member could be a calibration screw.

A method of installing a medical device according to any of theembodiments herein is further provided. The method comprises the stepsof exposing the hip joint through a surgical or arthroscopic procedure,fixating the first piece of the medical device to the pelvic bone,fixating the second piece of the medical device to the femoral bone,placing the first piece in connection with the second piece, and holdingthe first piece to the second piece using the releasing member.

According to one embodiment the step of holding the first piece to thesecond piece using the releasing member comprises holding the firstpiece to the second piece using an elastic member. According to yetanother embodiment the step of holding the first piece to the secondpiece using the elastic member, comprises holding the first piece to thesecond piece using an elastic band.

According to one embodiment the step of holding the first piece to thesecond piece using the releasing member could comprise holding the firstpiece to the second piece using a rupturing member. The rupturing membercould be a rupturing band.

According to other embodiment the step of holding the first piece to thesecond piece comprises holding the first piece to the second piece usinga spring loaded member.

A medical device for implantation in a hip joint of a patient is furtherprovided. The medical device comprises a first and second piece and areleasing member adapted to, in a first state hold the first pieceattached to the second piece, and in a second state release the firstpiece from the second piece. The releasing member is adapted to changefrom the first state to the second state when a pre-determined strain isplaced on the releasing member.

According to one embodiment the first piece comprises a ball shapedpiece, adapted to replace at least the surface of the caput femur in thehip joint.

According to one embodiment the second piece comprises a bowl shapedpiece, adapted to replace at least the acetabulum surface in the hipjoint.

According to another embodiment the first piece comprises a ball shapedpiece and the second piece comprises a bowl shaped piece, and the ballshaped piece is adapted to be placed in the bowl shaped piece to replacea functioning hip joint, thereby creating an entirely artificial hipjoint. The ball shaped piece could be adapted to be fixated in the bowlshaped piece using the releasing member.

The releasing member according to any of the embodiments could beadapted to non-invasively change from the first state to the secondstate and from the second state to the first state, when apre-determined strain is placed on said releasing member. Thereby, ifdislocated the hip joint can be reinstated without the need of asurgical procedure.

The at least one of the first and second piece could comprise at leasttwo part adapted to be in contact with each other when the medicaldevice is implanted in the patient.

The first and/or the second piece could be adapted to be introducedthrough a hole in the pelvic bone of the patient.

According to one embodiment the at least two pieces are adapted to bemechanically fixated to each other after the at least two pieces havebeen introduced into the hip joint through a hole in the pelvic bone ofthe patient

Releasing Member

According to one embodiment the first piece of the medical devicecomprises the releasing member. Which could be a ball shaped piece ofthe medical device comprising the releasing member. According to anotherembodiment the second piece of the medical device comprises thereleasing member. Which could be a bowl shaped piece of the medicaldevice comprising the releasing member.

According to another embodiment the releasing member comprises anelastic portion, which in turn could comprise an elastic material.

According to yet another embodiment the releasing member comprises abendable and/or flexible and/or compressible portion. It is furthermoreconceivable that the releasing member comprises a movable portion ormovable part.

In the embodiments where the medical device comprises an elasticportion, the elastic portion could comprise a spring and/or an elasticband, which could be adapted to at least partly encircle the ball shapedpiece and thereby holding the ball shaped piece in the bowl shapedpiece. The elastic band could further be adapted to be placed betweenthe ball shaped piece and the bowl shaped piece.

According to yet another embodiment the releasing member comprises amagnet adapted to hold the first piece to the second piece.

According to another embodiment the releasing member comprises a rupturedevice adapted to fail at a predetermined strain, for releasing thefirst piece from the second piece. The rupture device could comprise arupture band, which could be adapted to at least partly encircle theball shaped piece. The rupture band could, according to one embodimentbe placed between the ball shaped piece and the bowl shaped piece, andcould comprise a rupture pin.

The releasing member could comprise multiple holding members, and theholding members or holding member could be adapted to slide against saidfirst piece and/or adapted to roll against said first piece. The holdingmember could comprise a ball shaped holding member.

First Piece

According to one embodiment, the first piece comprises at parts adaptedto be in contact with each other when the medical device is implanted inthe patient.

The first piece, according to any of the embodiments, could be adaptedto be introduced through a hole in the pelvic bone of the patient.

According to one embodiment, one of the at parts is adapted to bemechanically fixated to the second of the at parts after the at partshave been introduced into the hip joint through a hole in the pelvicbone of the patient.

The first piece could comprise a flexible portion and/or an elasticportion adapted to enable the medical device to be inserted through ahole in the pelvic bone. The elastic portion could enable thecompression of the first piece in at least one direction.

The first piece could comprise a first area and a second area, the firstarea could comprise a first material adapted to be elastic and thesecond area could comprise a second material adapted to be elastic, andthe first material could be adapted to be more elastic than the secondmaterial.

Second Piece

According to one embodiment the second piece comprises at least twoparts adapted to be in contact with each other when the medical deviceis implanted in the patient Me second piece could be adapted to beintroduced through a hole in the pelvic bone of the patient.

According to another embodiment, one of said at least two parts could beadapted to be mechanically fixated to a second of the at least two partsafter the at least two parts have been introduced into the hip jointthrough a hole in the pelvic bone of the patient.

According to yet another embodiment the medical device comprises atleast a three-dimensionally curved hip joint surface comprising: aninner surface, and an outer surface. The inner surface comprises sixdifferent points: a first point, a second point, a third point, a fourthpoint, a fifth point, and a sixth point, all points located on differentplaces along a length axis of the inner surface. A first straight line,reaching from said first point to said second point is parallel to asecond straight line reaching from said third point to said fourthpoint, which in turn is parallel to a third straight line reaching fromsaid fifth point to said sixth point. Furthermore, the first and thirdstraight lines are shorter than said second straight line, and saidsecond straight line is positioned between said first and said thirdstraight lines.

The medical device could further comprise a calibration member forcalibrating the pre-determined strain required for said releasing memberto change from said first state to said second state. The calibrationmember could be a calibration screw.

The normal hip joint have a collum femur, having an axial distributionleading to a caput femur, having a substantially ball shapedconfiguration with a maximum diameter substantially perpendicular to thecentre axis of the prolongation of said axial distribution of saidcollum femur. The caput femur is placed in a bowl shaped acetabulumcreating the hip joint The bowl shaped acetabulum have an opening and asecond axial distribution with a center axis from the center of thebottom of the acetabulum bowl and following the center of the bowltowards the opening and caput femur, wherein the acetabulum have amaximum diameter substantially perpendicular to the center axis of thesecond axial distribution of the acetabulum. The prolongation of thecentre axis of the axial distribution is identical to the center axis ofthe second axial distribution, when the caput femur is in a centered andsymmetrical position in the acetabulum bowl. The medical devicecomprises two artificial hip joint surfaces, the first piece comprises;the artificial hip joint surface comprising, an artificial caput femursurface adapted to at least partly replace and replacing the jointsurface of the caput femur, on the opposite side of collum femur, andadapted to, when mounted in the joint, be placed in the acetabulum bowlor an artificial replacement therefore. The artificial caput femursurface, comprising at least one first beyond part of the surfaceadapted to cover and/or going into the bone of said caput femur on atleast a part of said caput femur beyond the maximum diameter of saidcaput femur, away from said acetabulum bowl towards said collum femur,when mounted on said caput femur in its functional position in the jointThe at least one first beyond part is adapted to have a closestperpendicular distance to said center axis, being smaller than thedistance between the periphery of said maximum diameter of said caputfemur and said center axis, thus adapted to create and creating a morestable position of said artificial caput femur surface when mounted onsaid caput femur in said functional position. The beyond part comprisesat least a part of the releasing member.

The normal hip have a collum femur having an axial distribution leadingto a caput femur having a substantially ball shaped configuration with amaximum diameter substantially perpendicular to the centre axis of theprolongation of said axial distribution of said collum femur. The caputfemur is placed in a bowl shaped acetabulum creating the hip joint Thebowl shaped acetabulum have an opening and a second axial distributionwith a center axis from the center of the bottom of said acetabulum bowland following the center of said bowl towards the opening and caputfemur. The acetabulum have a maximum diameter substantiallyperpendicular to the center axis of said second axial distribution ofthe acetabulum, the prolongation of the center axis of the axialdistribution is identical to the center axis of the second axialdistribution, when the caput femur is in a centered and symmetricalposition in the acetabulum bowl. The medical device comprises twoartificial hip joint surfaces, the artificial hip joint surfacecomprising, an artificial acetabulum surface adapted to at least partlyreplace and replacing the joint surface of the acetabulum, and adaptedto be placed onto the caput femur, or an artificial replacementtherefore, when mounted in the hip joint The artificial acetabulumsurface, comprises at least one first beyond part of the surface adaptedto cover at least a part of the caput femur or the artificialreplacement therefore beyond the maximum diameter of the acetabulum,away from the acetabulum bowl towards the collum femur, when mountedonto the caput femur or an artificial replacement therefore, in itsfunctional position in the hip joint. The at least one first beyond partadapted to have a closest perpendicular distance to said centre axis,being smaller than the distance between the periphery of said maximumdiameter of said artificial acetabulum surface and said centre axis,thus adapted to create and creating a more stable position of theartificial acetabulum surface when mounted on the caput femur or anartificial replacement therefore, in said functional position in saidhip joint. The first beyond part comprises the releasing member.

The releasing member, according to any of the embodiments could comprisean elastic portion and/or a bendable portion and/or a flexible portionand/or a compressible portion and/or a movable portion and/or a movablepart, for enabling the releasing of the first piece from the secondpiece.

A method of installing a medical device according to any of theembodiments is further provided, the method comprises the steps ofexposing the hip joint through a surgical or arthroscopic procedure,fixating said first piece of said medical device to the femoral bone,fixating said second piece of said medical device to the pelvic bone,placing said first piece in connection with said second piece, andholding said first piece to said second piece using said releasingmember.

According to one embodiment, the step of holding the first piece to thesecond piece comprises holding the first piece to the second piece usingan elastic member.

According to one embodiment, the step of holding the first piece to thesecond piece comprises holding the first piece to the second piece usinga rupturing member.

According to one embodiment, the step of holding the first piece to thesecond piece comprises holding the first piece to the second piece usinga spring loaded member.

According to one embodiment, the step of holding the first piece to thesecond piece comprises holding the first piece to the second piece usingan elastic band.

According to one embodiment, the step of holding the first piece to thesecond piece comprises holding the first piece to the second piece usinga rupturing band.

Please note that any embodiment or part of embodiment, feature, method,associated system, part of system described herein or in the associatedfigures may be combined in any way.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is now described, by way of example, with reference to theaccompanying drawings, in which

FIG. 1 shows the hip joint in section.

FIG. 2 shows the first step in a conventional hip joint surgery,

FIG. 3 shows the step of removing the caput femur from the hip jointcapsule,

FIG. 4 shows the incisions made in a laparoscopic/arthroscopic method,

FIG. 5 shows the instruments used in a laparoscopic/arthroscopic method,

FIG. 6 shows the step of creating a hole in the pelvic bone of apatient,

FIG. 7 shows details of a laparoscopic operation,

FIG. 8 shows the patient in section when a laparoscopic operation isperformed,

FIG. 9 shows the hip joint in section when a medical device has beenprovided, in a first state,

FIG. 10 shows the hip joint in section when a medical device has beenprovided, in a second state,

FIG. 11 shows the hip joint in section when a medical device has beenprovided, in a first state,

FIG. 12 shows the hip joint in section when a medical device has beenprovided, in a second state,

FIG. 13 shows the medical device in section,

FIG. 14 shows an alternative embodiment of the medical device shown inFIG. 11, in a first state,

FIG. 15 shows an alternative embodiment of the medical device shown inFIG. 11, in a second state,

FIG. 16 shows the hip joint in section, when a medical device accordingto yet another embodiment is provided, in a first state,

FIG. 17 shows the hip joint in section, when a medical device accordingto yet another embodiment is provided, in a second state,

FIG. 18 a shows the hip joint in section when a medical devicecomprising an elastic or rupture band has been provided, in a firststate,

FIG. 18 b shows the medical device of FIG. 18 a, in section, in a firststate,

FIG. 19 a shows the hip joint in section when a medical devicecomprising an elastic or rupture band is provided, in a second state,

FIG. 19 b shows the medical device of FIG. 19 a, in section, in a secondstate,

FIG. 20 shows the hip joint in section, when a medical device accordingto yet another embodiment has been provided, in a first state,

FIG. 21 shows the hip joint in section, when a medical device accordingto yet another embodiment has been provided, in a second state,

FIG. 22 shows the hip joint in section, when a medical device comprisinga rupture band has been provided, in a first state,

FIG. 23 shows the hip joint in section, when a medical device comprisinga rupture band has been provided, in a second state,

FIG. 24 shows the hip joint in section, when a medical device accordingto yet another embodiment has been provided, in a first stab,

FIG. 25 shows the hip joint in section, when a medical device accordingto yet another embodiment has been provided, in a second state,

FIG. 26 shows the hip joint in section when a medical device, accordingto an embodiment where the artificial acetabulum surface compriseselastic elements, has been provided, in a first state,

FIG. 27 shows the hip joint in section when a medical device, accordingto an embodiment where the artificial acetabulum surface compriseselastic elements, has been provided, in a second state,

FIG. 28 shows an alternative embodiment of the medical device shown inFIG. 26,

FIG. 29 shows the hip joint in section when a medical device adapted tohold the caput femur 5, or an artificial replacement therefore, to theartificial acetabulum by means of magnetic force, has been provided, ina first state,

FIG. 30 shows the hip joint in section when a medical device adapted tohold the caput femur 5, or an artificial replacement therefore, to theartificial acetabulum by means of magnetic force, has been provided, ina second state,

FIG. 31 shows, schematically, the artificial acetabulum or artificialcaput femur,

FIG. 32 shows the artificial acetabulum or artificial caput femur, insection,

FIG. 33 shows the principle of an alternative embodiment,

FIG. 34 shows the principle of an alternative embodiment,

FIG. 35 shows the principle of an alternative embodiment,

FIG. 36 a shows an embodiment of the locking/releasing member,

FIG. 36 b shows the hip joint in section in an embodiment when thelocking/releasing member locks an artificial caput femur in artificialacetabulum.

FIG. 36 c shows the hip joint in section in an embodiment when thelocking/releasing member releases the artificial caput femur from theartificial acetabulum.

FIG. 36 d shows another embodiment of the locking/releasing member,

FIG. 36 e shows the hip joint in section in an embodiment when thelocking/releasing member according to the embodiment of FIG. 36 d locksthe artificial caput femur to the artificial acetabulum.

FIG. 36 f shows the hip joint in section in an embodiment when thelocking/releasing member according to the embodiment of FIG. 36 dreleases the artificial caput femur from the artificial acetabulum.

FIG. 36 g shows another embodiment of the locking/releasing member,

FIG. 36 h shows another embodiment of the locking/releasing member,

FIG. 36 i shows the hip joint in section when an artificial hip joint isbeing assembled,

FIG. 36 j shows the hip joint in section when an artificial hip joint isbeing assembled,

FIG. 36 k shows the hip joint in section when an artificial hip joint isassembled,

FIG. 36 m shows the hip joint in section when an artificial hip joint isin its releasing state.

DETAILED DESCRIPTION

Elasticity is to be understood as a materials ability to deform in anelastic way.

Elastic deformation is when a material deforms under stress (e.g.external forces), but returns to its original shape when the stress isremoved. A more elastic material is to be understood as a materialhaving a lower modulus of elasticity. The elastic modulus of an objectis defined as the slope of its stress-strain curve in the elasticdeformation region. The elastic modulus is calculated as stress/strain,where stress is the force causing the deformation, divided by the areato which the force is applied; and strain is the ratio of the changecaused by the stress.

Stiffness is to be understood as the resistance of an elastic body todeformation by an applied force.

Functional hip movements are to be understood as movements of the hipthat at least partly correspond to the natural movements of the hip. Onsome occasions the natural movements of the hip joint might be somewhatlimited or altered after hip joint surgery, which makes the functionalhip movements of a hip joint with artificial surfaces somewhat differentthan the functional hip movements of a natural hip joint.

The functional position of an implantable medical device or prosthesisis the position in which the hip joint can perform functional hipmovements. The final position is to be understood as a functionalposition in which the medical device needs no further position change.

Biocompatible material is to be understood as being a material with lowlevel of immune response. Biocompatible materials are sometimes alsoreferred to as biomaterials. Analogous is biocompatible metals abiocompatible metal with low immune response such as titanium ortantalum. The biocompatible metal could also be a biocompatible alloycomprising at least one biocompatible metal.

Form fitting is to be understood as an element having a part or sectionwhich is adapted to enable a mechanical connection of said element to atleast one other element using said part or section. Form fittedstructure is a structure of an element which enables form fitting.

The medical device according to any of the embodiments could comprise atleast one material selected from a group consisting of:polytetrafluoroethylene (PTFE), perfluoroalkoxy (PFA) and fluorinatedethylene propylene (FEP). It is furthermore conceivable that thematerial comprises a metal alloy, such as cobalt-chromium-molybdenum ortitanium or stainless steel, or polyethylene, such as cross-linkedpolyethylene or gas sterilized polyethylene. The use of ceramic materialis also conceivable, in the contacting surfaces or the entire medicaldevice such as zirconium or zirconium dioxide ceramics or aluminaceramics. The part of the medical device in contact with human bone forfixation of the medical device to human bone could comprise a poorhousestructure which could be a porous micro or nano-structure adapted topromote the growth-in of human bone in the medical device for fixatingthe medical device. The porous structure could be achieved by applying ahydroxy-apatite (HA) coating, or a rough open-pored titanium coating,which could be produced by air plasma spraying, a combination comprisinga rough open-pored titanium coating and a HA top layer is alsoconceivable. The contacting parts could be made of a self lubricatedmaterial such as a waxy polymer, such as PTFE, PFA, FEP, PE and UHMWPE,or a powder metallurgy material which could be infused with a lubricant,which preferably is a biocompatible lubricant such as a Hyaluronic acidderivate. It is also conceivable that the material of contacting partsor surfaces of the medical device herein is adapted to be constantly orintermittently lubricated. According to some embodiments the parts orportions of the medical device could comprise a combination of metalmaterials and/or carbon fibers and/or boron, a combination of metal andplastic materials, a combination of metal and carbon based material, acombination of carbon and plastic based material, a combination offlexible and stiff materials, a combination of elastic and less elasticmaterials, Corian or acrylic polymers.

In the following a detailed description of preferred embodiments of thepresent invention will be given. In the drawing figures, like referencenumerals designate identical or corresponding elements throughout theseveral figures. It will be appreciated that these figures are forillustration only and are not in any way restricting the scope of theinvention. Thus, any references to direction, such as “up” or “down”,are only referring to the directions shown in the figures. Also, anydimensions etc. shown in the figures are for illustration purposes.

FIG. 1 shows the hip joint of a human patient in section. The hip jointcomprises a caput femur 5, or an artificial replacement therefore,placed at the very top of collum femur 6 which is the top part of thefemoral bone 7. The caput femur 5, is in connection with the acetabulum8 which is a bowl shaped part of the pelvic bone 9. Both the caput femursurface 10 and the acetabulum surface 11 is covered with articularcartilage 13 which acts as a cushion in the hip joint In patients withhip joint osteoarthritis, this articular cartilage 13 is abnormally worndown due to a low grade inflammation. The hip joint is surrounded by thehip joint capsule 12 which provides support for the joint and hindersluxation. After conventional hip joint surgery, penetrating the hipjoint capsule 12, the capsule 12 is dramatically weakened due to thelimited healing possibilities of its ligament tissue. By performing hipjoint surgery without damaging the hip joint capsule 12 the patient canfully recover and place equal amount of strain on an artificial joint asis possible on a natural one.

FIG. 2 shows a lateral view of a conventional hip joint surgery where anincision 112 is made in the thigh 113 enabling the surgeon to reach thefemoral bone 7 on which the caput femur 5 is located. The femoral bone 7is then extracted from the hip joint capsule 12 exposing the caput femur5, which is replaced or resurfaced during the operation.

FIG. 3 shows the placing of an artificial caput femur surface 45 on thecaput femur 5 in conventional surgery. However according to otherembodiments of the state of the art the entire collum femur 6 is removedusing a bone saw, after which a prosthetic part comprising the caputfemur is fixated in the femoral bone using bone cement or mechanicalfixating members. A bowl shaped cup is then placed in the acetabulum 8to act as the contacting surface against the new artificial caput femur45 when the hip joint is performing functional hip movements in itsfunctional position. According to prior art, the artificial caput femursurface and the artificial acetabulum surface is being kept together bymeans of the hip joint capsule, which is dramatically weakened when thecapsule has been penetrated during an operation.

An alternative way of operating a hip joint will now be described.

FIG. 4 shows a frontal view of the body of a human patient Alaparoscopic/arthroscopic method of operating the hip joint, from theopposite side from acetabulum, is according to a first embodimentperformed starting with making small incisions 14 in the abdominal wallof the human patient The small incisions enable the surgeon to insertlaparoscopic trocars into the abdomen of the human patient. According tothe first embodiment the incisions 14 passes through the rectusabdominis and peritoneum in to the abdomen of the human patent.According to a second preferred embodiment the small incisions 15 isconducted through the rectus abdominis and in to the pelvic area, belowperitoneum. According to a third embodiment the small incisions 16 isperformed just between Ilium and the surrounding tissue, an incision 16which could enable the pelvic bone to be dissected with very littlepenetration of fascia and muscular tissue. According to a fourthembodiment the incision 17 is made in the inguinal channel. In all ofthe four embodiments the tissue surrounding the pelvic bone 9 in thearea opposite to acetabulum 8 is removed or penetrated which enables thesurgeon to reach the pelvic bone 9.

It is obvious that the methods described may both be combined or alteredreaching the same goal to dissect the pelvic bone on the opposite sideof the acetabulum.

After dissecting the pelvic bone 9 a hole 18 is created in the bone 9,as shown in FIG. 6. The hole 18 passes through the pelvic bone from theopposite side from acetabulum 8 and into the hip joint 19. The medical,according to any one the embodiments herein could be adapted to beinserted through the hole 18 in the pelvic bone 9. For this purpose themedical device could comprise a first and second piece adapted to beintroduced through the hole 9 and thereafter be mounted and mechanicallyfixated to each other in situ for creating a mounted medical device.This is further explained with reference to FIGS. 36 h and 36 i.

The medical device, or the first and second piece of the medical devicecould be adapted to be introduced through a hole 18 in the pelvic bone9, having a cross sectional area smaller than 530 m2 or hole 18 in thepelvic bone 9 having a cross sectional area smaller than 380 mm2, or ahole 18 in the pelvic bone 9 having a cross sectional area smaller than250 mm2, or a hole in the pelvic bone having a cross sectional areasmaller than 180 mm2, or a hole 18 in the pelvic bone 9 having a crosssectional area smaller than 110 mm2. A smaller hole creates a lessinvasive procedure in which it is further conceivable that the medicaldevice needs to be mounted from more than two pieces. In someembodiments the medical device is mounded from several pieces adapted tobe mechanically connected to a base piece.

FIG. 5 shows a frontal view of the body of a human patient, illustratingthe laparoscopic method of operating the hip joint from the oppositeside from acetabulum 8. The hip joint comprises the acetabulum 8 and thecaput femur 5. The small incisions 14 in the abdominal wall of the humanpatient allows the insertion of laparoscopic trocars 33 a,b,c into thebody of the patients. Whereafter one or more camera 34, a surgicalinstrument adapted to create a hole in the pelvic bone 35, orinstruments 36 for introducing, placing, connecting, attaching, creatingor filling prosthesis or prosthetic parts, can be inserted into saidbody through said laparoscopic trocars 33 a,b,c.

FIG. 6 shows the creation of a hole 18 in the pelvic bone 9 from theabdominal side of acetabulum using a bone contacting organ 22.

FIG. 7 shows a close-up of the insertion 37 of prosthetic parts 38 intothe patients body through said laparoscopic trocars 33 a,b,c. Theprosthetic parts could be parts of the artificial caput femur 45, theartificial acetabulum 65 or prosthetic parts or bone material adapted tobe used to close the hole 18 created in the pelvic bone 9.

FIG. 8 shows a lateral view of the body of a human patient, with the hipjoint shown in section. The hip joint comprises a caput femur 5 placedat the very top of collum femur 6 which is the top part of the femurbone 7. The caput femur 5 is in connection with the acetabulum 8 whichis a bowl shaped part of the pelvic bone 9. laparoscopic trocars 33a,b,c is being used to reach the hip joint 39 with one or more camera34, a surgical instrument 35 adapted to create a hole in the pelvic bone9, or instruments 36 for introducing, placing, connecting, attaching,creating or filling prosthesis or prosthetic parts.

FIG. 9 shows an artificial bowl shaped acetabulum cup 65 placed in thepelvic bone 9. The artificial bowl shaped acetabulum cup 65 comprisesreleasing members 801 adapted, in a first state, to hold the caput femur5 which is a ball shaped piece attached to the collum femur 6 inposition in the hip joint to the artificial bowl shaped acetabulum cup65 placed in the pelvic bone 9. In a second state the releasing member801 is adapted to release the caput femur 5, or an artificialreplacement therefore, from the artificial bowl shaped acetabulum cup 65placed in the pelvic bone 9. The releasing member 801 is adapted tochange from the first state to the second state when a pre-determinedstrain is placed on the releasing member 801. The strain preferablybeing caused by an abnormal movement of the hip joint, e.g. as theresult of the patient falling. According to the embodiment shown in FIG.9 the releasing member 801 comprises an elastic portion comprisingelastic material, in the embodiment shown being the entire releasingmember 801. The releasing member is adapted to non-invasively be able tochange from the first state to the second state and from the secondstate to the first state, when a pre-determined strain is placed on thereleasing member 801.

FIG. 10 shows the hip joint in section when the releasing member 801 isin it second state, wherein the releasing member 801 is adapted torelease the caput femur 5, or an artificial replacement therefore, fromthe artificial bowl shaped acetabulum cup 65 placed in the pelvic bone9. The releasing member 801 has changed from the first state to thesecond state because of a pre-determined strain has been placed on thereleasing members 801.

FIG. 11 shows the medical device according to an embodiment where theartificial bowl shaped acetabulum surface 65 comprises releasing members801 comprising holding members 802 a,b adapted to slide against thecaput femur 5, or an artificial replacement therefore. The holdingmembers are adapted to, in a first state, hold the caput femur 5, or anartificial replacement therefore, which is a ball shaped part attachedto the collum femur 6 in position in the hip joint to the artificialbowl shaped acetabulum cup 65 placed in the pelvic bone 9. In a secondstate the releasing member 801 is adapted to release the caput femur 5,or an artificial replacement therefore, from the artificial bowl shapedacetabulum cup 65 placed in the pelvic bone 9. The holding members 802a,b are spring loaded through a spring 803 a,b being placed between acalibration member, being a calibration screw 804 a,b, and the holdingmembers 802 a,b. The force exerted on the holding members 802 a,b fromthe spring 803 a,b is adapted to hold the caput femur 5, or anartificial replacement therefore, in the artificial acetabulum 65 innormal, functional hip joint movements, but release the caput femur 5,or an artificial replacement therefore, from the artificial acetabulum65 when a pre-determined strain is placed on the releasing memberpreferably being caused by an abnormal movement of the hip joint, e.g.as the result of the patient falling. Me calibration screws 804 a,benables the pre-determination of the strain which will cause the holdingmembers 802 a,b to change from being in a first state to being in asecond state.

FIG. 12 shows the releasing members in their second state, when apre-determined strain has been exceeded, preferably being caused by anabnormal movement of the hip joint, e.g. as the result of the patientfalling. The holding members 802 a,b are retracted into sleeves 806 ofthe artificial acetabulum surface 65, thereby compressing the springs803 a,b. The retraction of the holding members 802 a,b causes the caputfemur 5, or an artificial replacement therefore, to bedislocated/luxated from its position in the artificial acetabulumsurface 65, which, when large strain is placed on the hip joint andfemoral bone 7, reduces the risk of the patient fracturing the femoralbone 7 or the pelvic bone 9. The holding members 802 a,b are adapted tonon-invasively be able to change from the first state to the secondstate and from the second state to the first state, when apre-determined strain is placed on the holding members 802 a,b.

FIG. 13 shows the artificial acetabulum 65 in section with the holdingmembers 802, placed in sleeves 806 evenly distributed along thecross-section of the artificial acetabulum 65, holding the caput femur5, or an artificial replacement therefore, in position in the artificialacetabulum 65.

FIG. 14 shows an alternative embodiment of the principle shown in FIGS.11-13, wherein the holding members 802 a,b, comprises ball shapedmembers 805 a,b in contact with the caput femur 5, or an artificialreplacement therefore, ant being adapted to roll against the caput femur5, or an artificial replacement therefore, holding the caput femur 5, oran artificial replacement therefore, in place in the artificialacetabulum 65 by the holding members 802 a,b exerting force on the caputfemur 5, or an artificial replacement therefore, through the contactwith the springs 803 a,b supported by the calibration screws 804 a,b.

FIG. 15 shows the releasing members in their second state, when apre-determined strain has been exceeded, preferably being caused by anabnormal movement of the hip joint, e.g. as the result of the patientfalling. The holding members 802 a,b, comprising the ball shaped members805 a,b, are retracted into sleeves 806 of the artificial acetabulumsurface 65, thereby compressing the springs 803 a,b. The retraction ofthe holding members 802 a,b causes the caput femur 5, or an artificialreplacement therefore, to be dislocated/luxated from its position in theartificial acetabulum surface 65, which, when large strain is placed onthe hip joint and femoral bone 7, reduces the risk of the patientfracturing the femoral bone 7 or the pelvic bone 9. The holding members802 a,b are adapted to non-invasively be able to change from the firststate to the second state and from the second state to the first state,when a pre-determined strain is placed on the holding members 802 a,b,which enables the caput femur 5, or an artificial replacement therefore,to be replaced in the artificial acetabulum 65 without a surgicalprocedure.

FIG. 16 shows the medical device in an embodiment wherein the releasingmembers 801 comprises a rupture device 807, 808, 809 adapted to fail ata pre-determined strain. According to this embodiment the rupture deviceis a rupture pin 807, 808, 809 comprising a base part 809 a,b fixated tothe artificial acetabulum 65 and a rupture part 807 a,b attached to thebase part 809 a,b through a weakened section 808 a,b, in which sectionthe rupture part 807 a,b is detached from the base part 809 a,b when apredetermined strain is placed on the rupture device in contact with thecaput femur 5, or an artificial replacement therefor.

FIG. 17 shows the medical device according to the embodiment of FIG. 16when the rupture device has failed due to a pre-determined strain on therupture device being exceeded. According to one embodiment, (not shown)the rupture parts 807 a,b are secured to the base part through asecurity wire keeping rupture parts 807 a,b in proximity to the basepart 809 a,b even after the failure of the rupture device.

FIG. 18 a shows the medical device according to an embodiment where theartificial acetabulum 65 comprises a circular sleeve 806, in which anelastic or rupture band 810 is provided. The elastic or rupture band 810is adapted to at least partly encircle the ball shaped caput femur 5, orartificial replacement therefore. When a pre-determined strain is placedon the elastic or rupture band 810 the circular opening encircling thecaput femur 5, or an artificial replacement therefore, is expanded andthe caput femur 5, or an artificial replacement therefore, is releasedfrom the artificial acetabulum 65, to which it is held by means of theelastic band 810. In embodiments where the medical device comprises arupture band 810 holding the caput femur 5, or an artificial replacementtherefore, in the artificial acetabulum 65, a weakened portion 811 ofthe band 810 fails and thus the circular opening encircling the caputfemur 5, or an artificial replacement therefore, is expanded and thecaput femur 5, or an artificial replacement therefore, is released fromthe artificial acetabulum 65. In the embodiments where the band 810 isan elastic band 810 it is conceivable that the band 810 comprises anelastic part or section, or that the entire band 810 is made of anelastic material.

FIG. 18 b shows the medical device in section when the elastic orrupturing band 810, holding the caput femur 5, or an artificialreplacement therefore, is placed in a circular sleeve 806 in theartificial acetabulum 65. An opening or weakened portion 811 is providedperpendicular to the circumference of the band 810.

FIG. 19 a shows the medical device in a second state where the caputfemur 5, or an artificial replacement therefore, is released from theconnection with the acetabulum, after a pre-determined stain has beenplaced on the elastic or rupture band 810. As shown in FIG. 19 b the gapor weakened part has been expanded, thereby allowing the caput femur, oran artificial replacement therefore, 5 to pass through the openingdefined by the elastic or rupture band 810. The medical device could beadapted to non-invasively be able to change from the first state to thesecond state and from the second state to the first state, when apre-determined strain is placed on the band 810, which enables the caputfemur 5, or an artificial replacement therefore, to be replaced in theartificial acetabulum 65 without a surgical procedure.

FIG. 20 shows the medical device according to an embodiment where thereleasing member 801 comprises an elastic wing of the artificialacetabulum 65, which is assisted by an elastic or rupture band 810encircling the medical device by enclosing the caput femur 5, or anartificial replacement therefore, in the artificial acetabulum 65passing beyond the point of the caput femur 5, or an artificialreplacement therefore, having a largest cross-sectional distance. Theelastic or rupture band 810 is held in place to the artificialacetabulum 65 by means of the band 810 being placed in a groove alongthe circumference of the artificial acetabulum 65. However, said groovecould be assisted or replaced by an adhesive or a mechanical fixationelement

FIG. 21 shows the medical device when in it second state, in which thereleasing member 801 releases the caput femur 5, or an artificialreplacement therefore, from the artificial acetabulum 65. In embodimentswhen the band 810 is an elastic band 810 it is expanded, therebyenlarging the hole through which the caput femur 5, or an artificialreplacement therefore, can pass. In embodiment where the band 810 is arupture band, the band 810 has failed and thereby the caput femur 5, oran artificial replacement therefore, is held in place solely by thereleasing member 801 which is adapted to release the caput femur 5, oran artificial replacement therefore, at a pre-defined strain. Themedical device could be adapted to non-invasively be able to change fromthe first state to the second state and from the second state to thefirst state, when a pre-determined strain is placed on the band 810and/or the releasing member 801, which enables the caput femur 5, or anartificial replacement therefore, to be replaced in the artificialacetabulum 65 without a surgical procedure.

FIG. 22 shows the hip joint in section according to an embodiment wherethe caput femur 5, or an artificial replacement therefore, and collumfemur 6 have been replaced with a prosthetic part 818 fixated to thefemoral bone 7, either with bone cement, or without The prosthetic part818 comprises an artificial caput femur 812 having a cavity 816 in whicha rupture band 813 fixated to a fixation portion 814 of the artificialcaput femur 812, and a fixating portion 815 of the artificial acetabulum65. The cavity 816 is adapted to enable the artificial caput femur 812to perform normal functional hip movements inside the artificialacetabulum 65. The rupture band 813 is adapted to hold the artificialcaput femur 812 to the artificial acetabulum 65 in a first stab, andrelease the artificial caput femur 812 from the artificial acetabulumwhen a pre-determined strain is placed on the rupture band 813.

FIG. 23 shows the embodiment of the medical device according to FIG. 22,in a second state in which the rupture band 813 has failed and therebythe artificial caput femur 812 is released from the artificialacetabulum 65. The rupture band 813 could be fixated to a fixationportion 814 of the artificial caput femur 812, and/or a fixating portion815 of the artificial acetabulum 65 using: at least one screw, at leastone pin, form fitting, welding, adhesive, pin, wire, a ball mounted intoa bowl, a male portion of one part mounted into a female portion of theother part, a key introduced into a lock being portions of said parts,band, or other mechanical connecting members. The failing of the ruptureband 813 is preferably caused by an abnormal movement of the hip joint,e.g. as the result of the patient falling.

FIG. 24 shows a prosthetic part 818 according to an embodiment where theprosthetic part 818 is fixated to the femoral bone 7 and comprises acaput femur 812 comprising a cavity 816 adapted to enable the hip jointto perform functional hip joint movements while in a first state held tothe artificial acetabulum using an elastic bend 817 fixated to afixation portion 814 of the artificial caput femur 812, and a fixatingportion 815 of the artificial acetabulum 65, and a releasing member 801according to the embodiment shown in FIGS. 9 and 10. The combination ofthe releasing member 801 and the elastic band 817 is adapted to, in afirst state hold the prosthetic part 818 to the artificial acetabulum65, and in a second state release the prosthetic part 818 from theartificial acetabulum 65. According to another embodiment (not shown)the prosthetic part is held to the artificial acetabulum 65 solely usingthe elastic band 817, of course also supported by the remainder of thehip joint capsule and the affected muscles.

FIG. 25 shows the embodiment of the medical device according to FIG. 24,in a second state in which the elastic band 817 is stretched such thatthe prosthetic part 818 is released from the artificial acetabulumartificial acetabulum 65. The elastic band 817 could be fixated to afixation portion 814 of the artificial caput femur 812, and/or afixating portion 815 of the artificial acetabulum 65 using: at least onescrew, at least one pin, formfitting, welding, adhesive, pin, wire, aball mounted into a bowl, a male portion of one part mounted into afemale portion of the other part, a key introduced into a lock beingportions of said parts, band, or other mechanical connecting members.The failing of the rupture band 813 is preferably caused by an abnormalmovement of the hip joint, e.g. as the result of the patient falling.Preferably the elastic band 817 comprises an elastic part or section,which could be the entire elastic band 817, made from an elasticmaterial, such as an elastic polymer material such as: a copolymermaterial such as polystyrene, poly(ethylene-butylene) or polystyrene. Itis also conceivable that the material is a polyurethane elastomericmaterial, polyamide elastomeric materials and polyester elastomericmaterials elastic copolymers of ethylene and at least one vinyl monomersuch as, for example, vinyl acetates, unsaturated aliphaticmonocarboxylic acids, and esters of such monocarboxylic acids. Theelastic band 813 could comprise a barrier coating, which cannot bepenetrated by body cells. Preferably, the barrier coating comprises aParylene™ coating, or a biocompatible metal coating, such as gold,silver or titanium. According to other embodiments the elastic bandcomprises a spring type member, a combination of metal and plasticmaterials, a combination of metal and carbon based material or acombination of carbon and plastic based material.

FIG. 26 shows the hip joint in section in an embodiment where themedical device comprises a prosthetic part 819 adapted to be fixated tothe femoral bone 7. The prosthetic part comprises an artificial caputfemur which is adapted to comprise elastic elements 820 which act as areleasing member holding the artificial caput femur inside of theartificial acetabulum 65 fixated to the pelvic bone. The elasticelements 820 of the artificial caput femur, is preferably made of anelastic material, which for example could be an elastomeric polymermaterial or an elastic metal material. It is conceivable that theelastic material comprises an outer layer in connection with theartificial acetabulum 65 which is adapted to resist the wear from thecontact with the artificial acetabulum surface. The elastic element isadapted to compress when a pre-determined strain is placed on the hipjoint and thereby on the elastic elements 820. When the elastic elements820 are compressed the artificial caput femur is released from theartificial acetabulum 65.

FIG. 27 shows the medical device according to the embodiment shown inFIG. 26, in a second state, in which the elastic element 820 has beencompressed, following a pre-determined strain being placed on themedical device. The medical device is thereby placed in a second state,in which the artificial caput femur is released from the artificialacetabulum 65, wherein it has been held.

FIG. 28 shows an embodiment of the medical device in which the elasticelements 820 are further assisted by a spring 821 in connection with twoelastic elements 820, the spring 821 is compressed alongside the elasticmembers 820, when a pre-determined strain is placed on the prostheticpart 819 comprising the artificial caput femur.

FIG. 29 a shows the hip joint in section when a medical device for, in afirst state, holding the caput femur 5, or an artificial replacementtherefore, to the artificial acetabulum 65, and in a second statereleasing the caput femur 5, or an artificial replacement therefore fromthe artificial acetabulum 65. The medical device is adapted to changefrom being in the first state to being in the second state at apre-determined strain affecting the medical device by the connectionwith the pelvic bone 9 and the femoral bone 7, which reduced the risk ofthe patient fracturing the femoral bone 7 and/or the pelvic bone 9. Themedical device comprises magnets 823 or magnetic material 823 placed inthe artificial acetabulum 65, and magnets 822 or magnetic material 822placed in the caput femur 5 or an artificial replacement therefore.According to one embodiment a magnet 823 is placed in the artificialacetabulum having its south pole directed towards the caput femur 5, orartificial replacement therefore, and a magnet 822 placed in the caputfemur 5, or artificial replacement therefore, having its north poledirected towards the artificial acetabulum 65. However it is easilyunderstood by the skilled in the art that only one of the sides needs tobe magnetic whereas the other side merely needs to comprise magneticmaterial. Any combination of north and south ends and magnets/magneticmaterial is hence conceivable. The magnetic force described is adaptedto hold the caput femur 5, or an artificial replacement therefore, inthe acetabulum in normal use, enabling the hip joint to performfunctional hip joint movements, and release the caput femur 5, or anartificial replacement therefore, from the artificial acetabulum 65 whena predetermined strain is exceeded.

FIG. 29 b shows the medical device according to the embodiment of FIG.29 a in the second state, in which the caput femur 5, or an artificialreplacement therefore, is released from the artificial acetabulum 65 asa result of a pre-determined level of strain being exceeded.

FIG. 30 a shows the medical device according to another embodiment, in afirst state, in which the medical device comprises a prosthetic part 818fixated in the femoral bone 7. The prosthetic part 818 is separablealong a separation line 860 being placed in the area of collum femur.The proximal portion of the prosthetic part is placed in the artificialacetabulum 65 and clasped therein such that stable fixation of theprosthetic part 818 to the pelvic bone 9 is enabled. By the prostheticpart being separable, the prosthetic part comprises two park 861 and862, wherein the first part 861 is adapted to be placed in an artificialacetabulum 65, and the second part 862 is adapted to be fixated to thepelvic bone 9. The first 861 and second 862 park are connected to eachother by means of a breakpin 863 placed in a hole in the prosthetic part818. The break pin 863 is here a releasing member adapted to, in a firststate hold said first piece 861 attached to said second piece 862, andin a second state, break to release said first piece 861 from saidsecond piece 862. The breakpin 863 is adapted to break, and therebychanging from the first state to the second state, when a pre-determinedstrain is placed on the releasing member.

FIG. 30 b shows the medical device according to the embodiment in FIG.30 a when the breakpin 863 has failed and thereby changing from thefirst state to the second state releasing the first piece 861 from thesecond piece 862.

FIGS. 30 c and 30 d shows the replacement of a failed breakpin 863 byremoval of the pieces of the failed breakpin 863 (shown in FIG. 30 c)and replacing it with a new break pin 863 (shown in FIG. 30 d). Havingthe separation line 860 in the area of the collum femur and not ineither of the fixations to the femoral bone 5 or the pelvic bone 9 makesit possible for the prosthetic part 818 to remain in it fixations in thefemoral bone 5 and the pelvic bone 9 whilst still releasing the firstpart 861 from the second part 862 when a force exceeding a predeterminedvalue is exceeded, such that the prosthetic hip joint can dislocatewithout injuring the fixations.

FIG. 31 shows, schematically, how the artificial acetabulum travelsbeyond the maximum diameter of the caput femur 5, or an artificialreplacement therefore. That is, a cross-sectional distance of thelargest opening 52 is smaller than the largest cross sectional distanceof the caput femur 5 or an artificial replacement therefore

FIG. 32 a shows the medical device according to an embodiment in whichthe second piece comprises: an inner surface 906, and an outer surface907. The inner surface 906 comprises: a first point 908 a, a secondpoint 909 a, a third point 908 b, a fourth point 909 b, a fifth point908 c, and a sixth point 909 c, all points located on different placesalong a length axis of the inner surface. A first straight line 910 a,reaches from the first point 908 a to the second 909 a and is parallelto a second straight 910 b line reaching from the third point 908 b tothe fourth point 909 b, which in turn is parallel to a third straight910 c line, reaching from the fifth point 908 c to the sixth point 909c. The first 910 a and the third 910 c straight lines are shorter thanthe second straight line, and the second straight line is positionedbetween the first and third straight lines.

FIG. 32 c shows the medical device according to an embodiment where thereleasing member 801 comprises an elastic wing of the medical device,which is assisted by an elastic or rupture band 810 encircling themedical device by enclosing the caput femur 5, or a prostheticreplacement therefore, in the medical device passing beyond the point ofthe caput femur 5, or an artificial replacement therefore, having alargest cross-sectional distance. The elastic or rupture band 810 isheld in place to the medical device by means of the band 810 beingplaced in a groove along the circumference of the medical device.However, said groove could be assisted or replaced by an adhesive or amechanical fixation element.

FIG. 32 d shows the medical device when in its second state, in whichthe releasing member 801 releases the caput femur 5 or an artificialreplacement therefore, from the medical device. In embodiments when theband 810 is an elastic band 810 it could be expanded, thereby enlargingthe hole through which the caput femur 5, or a prosthetic replacementtherefore, can pass. In embodiments where the band 810 is a ruptureband, the band 810 fails and thereby the caput femur 5, or a prostheticreplacement therefore, is held in place solely by the releasing member801 which is a part of the extending portion adapted to release thecaput femur 5, or a prosthetic replacement therefore, at a pre-definedstrain. The medical device could be adapted to non-invasively be able tochange from the first state to the second state and from the secondstate to the first state, when a pre-determined strain is placed on theband 810 and/or the releasing member 801, which enables the caput femur5, or a prosthetic replacement therefore, to be replaced in the medicaldevice without a surgical procedure.

Opposite Embodiment

A general version of an opposite embodiment will now be described, thescope of the opposite embodiment is by no means limited to thisparticular version, on the contrary all of the above describedembodiment can be used in the opposite embodiment

FIG. 33 shows the hip joint in section when an artificial caput femursurface 112 is fixated to a surgically modified caput femur comprising aconcave artificial acetabulum surface 110 placed in the surgicallymodified caput femur. According to the embodiment shown in FIG. 33 anelongated member 206 is used as a guiding rod, guiding and centering theartificial acetabulum surface, and the artificial caput femur surface inthe hip joint The convex hip joint surface 112 is secured by thereleasing member 801 which is adapted to, in a first stab, hold theartificial caput femur, and in a second state release the artificialcaput femur, and change from a first to a second state when apre-determined strain is exceeded. The releasing member is fixated tothe surgically modified caput femur using screws 121. The surface of thelocking element 117 and the concave hip joint surface 117 is placed inconnection with the convex hip joint surface and could be made of afriction reducing material such as PTFE or a self lubricating powdermaterial. However it is also conceivable that the connecting surfacesare lubricated using an implantable lubrication system adapted tolubricate the medical device after said medical device has beenimplanted in the human patient, a solution conceivable in all of theabove described embodiments. According to the embodiment shown theelongated member 206 is inserted through the femoral bone, howeveraccording to other embodiments, not shown, the elongated member ispositioned inside of the hip joint from the acetabulum side.

FIG. 34 shows the placing of a prosthetic part 118 adapted to occupy thehole 18 created in the pelvic bone 9. The prosthetic part 118 comprisessupporting members 119 adapted to be in contact with the pelvic bone 9and assist in the carrying of the load placed on the medical device fromthe weight of the human patient. Furthermore FIG. 34 shows the fixationof a nut 120 to the attachment rod 113, which in turn is guided by theelongated member 206 which acts as a guiding rod.

FIG. 35 shows the hip joint in section when all the elements of themedical device has been fixated in the area of the hip joint or itssurroundings. The prosthetic part 113 adapted to occupy the hole 18 inthe pelvic bone 9 is here fixated with screws 121, however these screws121 could be assisted or replaced by an adhesive which could be appliedto the surface S between the prosthetic part and the pelvic bone 9. Theelongated member 206 which acts as a guiding rod has been retractedthrough the incision in the thigh.

The elastic or flexible part, piece or portion of any of the embodimentsherein could comprise an elastic polymer material such as: a copolymermaterial such as polystyrene, poly(ethylene-butylene) or polystyrene. Itis also conceivable that the material is a polyurethane elastomericmaterial, polyamide elastomeric materials and polyester elastomericmaterials elastic copolymers of ethylene and at least one vinyl monomersuch as, for example, vinyl acetates, unsaturated aliphaticmonocarboxylic acids, and esters of such monocarboxylic acids. Theelastic band 813 could comprise a bather coating, which cannot bepenetrated by body cells. Preferably, the bather coating comprises aParylene™ coating, or a biocompatible metal coating, such as gold,silver or titanium. According to other embodiments the elastic bandcomprises a spring type member, a combination of metal and plasticmaterials, a combination of metal and carbon based material or acombination of carbon and plastic based material.

The artificial acetabulum, according to any of the embodiments, couldcomprise one or more parts which could be fixated to the pelvic boneusing at least one screw, at least one pin, at least one portion of atleast one of the parts adapted to be introduced into the other part, theparts being adapted to be sliding into the other part, formfitting,welding, adhesive, pin, wire, a ball mounted into a bowl being portionsof said parts, a male portion of one part mounted into a female portionof the other part, a key introduced into a lock being portions of saidparts, band, or other mechanical connecting members.

FIG. 36 a shows an embodiment of a locking/releasing member 116, whereinthe locking/releasing member 116 comprises a surface 1353 adapted to bein contact with the artificial convex hip joint surface (112 in FIG. 36b), being a first piece, and slide against the hip joint surface, thelocking member 116 is adapted to, in a first state, lock the artificialcaput femur 112 to the artificial acetabulum surface (1340 in FIG. 36b), and in a second state, release said artificial caput femur 112 fromsaid artificial acetabulum 1340. The locking/releasing member 116 isadapted to change from the first to the second state when apredetermined amount of strain is placed on the locking/releasing member116. The locking/releasing member 116 according to the embodiment shownin FIG. 28 b, comprises four holding members, here being elasticportions 1351, and the locking/releasing member 116 is adapted to changefrom the first to the second state using the elasticity of the elasticportions 1351. The locking member 116 is adapted to be fixated to thefemoral bone 7 using screws adapted to be placed in holes 1352 adaptedtherefor. According to another embodiment (not shown) the holdingmembers 1351 comprises at least one holding member adapted to rollagainst the first piece, being the artificial convex hip joint surface112.

FIG. 36 b shows the hip joint in section when the two statelocking/releasing member 116 locks the artificial caput femur 112 in theartificial acetabulum 1340. The two state locking/releasing member 116is fixated to the femoral bone 7 using screws 121, and is here shown inits first state in which the locking/releasing member 116 locks theartificial caput femur 112 to the artificial acetabulum 1340.

FIG. 36 c shows the hip joint in section according to the embodiment ofFIG. 36 b, but when the two state locking/releasing member 116 is in itsecond state, in which the locking/releasing member 116 releases theartificial caput femur 112 from the artificial acetabulum surface 1340.The construction with the locking/releasing member 116 reduces the riskof strain placed on the artificial joint injuring the fixation points,i.e. the contact with bone; it further enables the artificial joint tobe non-invasively relocated in case of luxation.

FIG. 36 d shows an alternative embodiment of the two-statelocking/releasing member 116, in which the two-state locking/releasingmember 116 further comprises an elastic band 1361 adapted to encirclethe artificial caput femur 112, when implanted. The elastic band 1361could be an elastic polymer band, such as a polyurethane or siliconeband.

FIG. 36 e shows a hip joint in section when the two-statelocking/releasing member 116 has been implanted, and being in its firststate. The two-state locking/releasing member 116 is fixated to thefemoral bone 7 using screws 121.

FIG. 36 f shows the implantable device comprising the two-statelocking/releasing member 116 when in its second state, i.e. in the statein which the locking/releasing member 116 is adapted to release theartificial caput femur 112 through the elastic band 1361 encircling theartificial caput femur 112 is stretched so that the artificial caputfemur 112 can exit from the artificial acetabulum 1340. The constructionwith the locking/releasing member 116 reduces the risk of strain placedon the artificial joint injuring the fixation points, i.e. the contactwith bone; it further enables the artificial joint to be non-invasivelyrelocated in case of luxation.

The locking/releasing member 116 described with reference to FIGS. 36a-36 f are depicted in embodiments with a large hole in the pelvic bone9 occupied by a prosthetic part 118, however, it is equally conceivablethat the two state locking/releasing member 116 is used in embodimentswith a small hole in the pelvic bone 9, for a less invasive procedure,it is furthermore conceivable that the all of the embodiments disclosedof the medical device could be installed during conventional open hipjoint surgical procedure, penetrating the hip joint capsule. In thiscase the two state locking/releasing member 116 could be a part of afull prosthesis, such as the prosthesis disclosed with reference to FIG.22-28.

FIG. 36 g shows an embodiment of a locking/releasing member 116, whereinthe locking/releasing member 116 comprises a spring 1371 creating theelasticity needed to change from a first state to a second state forreleasing the artificial caput femur 112 from the artificial acetabulum1340. The locking/releasing member 116 is adapted to change from thefirst to the second state when a predetermined amount of strain isplaced on the locking/releasing member 116. According to the embodimentshown in FIG. 36 g the medical device further comprises a calibrationscrew 1372 placed in connection with the spring 1371 for calibrating theelasticity and thereby the amount of strain required for thelocking/releasing member to change from the first to the second state.

FIG. 36 h shows an embodiment of the locking/releasing member in whichthe locking/releasing member comprises four rupture pins 1373 adapted tofail at a pre-determined strain, for allowing the locking/releasing 116members to change from the first to the second state. The pins are,according to this embodiment, made from a brittle material which couldbe adapted for the particular patient. In other embodiments (not shown)the rupture pins 1373 could be replaced by a rupture band, similar tothe elastic band, but adapted to fail at a pre-determined strain, or arupture band placed centrally, such as disclosed with reference to FIG.23.

FIG. 36 i shows the hip joint in section when an artificial caput femur1375 a,b comprising two parts 1375 a and 1375 b is adapted to beinterconnected to form an interconnected artificial caput femur. Each ofthe two artificial parts 1375 a, 1375 b, furthermore comprises afixating portion 1374 a, 1374 b adapted to be fixated to the inside ofthe acetabulum 8. The artificial caput femur is, after theinterconnection, adapted to be placed in an artificial concaveacetabulum 1340 placed in the proximal portion of the femoral bone 7,for creating a functional hip joint in an opposite embodiment

FIG. 36 j shows the hip joint in section when the interconnectedartificial caput femur 1375 has been placed in the acetabulum 8, andbeen fixated using the fixating portion 1374. The locking/releasingmember 116 has been placed onto the artificial caput femur 1375 usingthe spring 1371 creating the elasticity required to enable theartificial caput femur 1375 to be placed such that the locking/releasingmembers clasps the artificial caput femur 1375.

FIG. 36 k shows the hip joint in section when the two statelocking/releasing member 116 locks the interconnected artificial caputfemur 1375 in the artificial acetabulum 1340. The two statelocking/releasing member 116 is fixated to the femoral bone 7 usingscrews 121, and is here shown in its first state in which thelocking/releasing member 116 locks the artificial caput femur 112 to theartificial acetabulum 1340.

FIG. 36 m shows the hip joint in section according to the embodiment ofFIG. 36 k, but when the two state locking/releasing member 116 is in itssecond state, in which the locking/releasing member 116 releases theartificial caput femur 112 from the artificial acetabulum surface 1340,by means of the spring 1371 creating the required elasticity. Theconstruction with the locking/releasing member 116 reduces the risk ofstrain placed on the artificial joint injuring the fixation points, i.e.the contact with bone; it further enables the artificial joint to benon-invasively relocated in case of luxation.

Please note that any embodiment or part of embodiment as well as anymethod or part of method could be combined in any way. All examplesherein should be seen as part of the general description and thereforepossible to combine in any way in general terms.

1. A medical device for implantation in a hip joint of a patient, saidmedical device comprising: a. a first piece, wherein i. said first pieceis adapted to be fixated to the pelvic bone, and ii. said first piececomprises a convex contacting surface adapted to be partially placedinside a concave contacting surface, b. a second piece, wherein i. saidsecond piece is adapted to be fixated to the femoral bone, and ii. saidsecond piece comprises a concave contacting surface adapted to partiallysurround said convex contacting surface of said first piece, whenimplanted, and c. a releasing member adapted to, in a first state holdsaid first piece attached to said second piece, and in a second staterelease said first piece from said second piece, and wherein saidreleasing member is adapted to change from said first state to saidsecond state when a predetermined strain is placed on said releasingmember.
 2. The medical device according to claim 1, wherein said convexcontacting surface of said first piece is at least partially spherical.3. The medical device according to claim 1, wherein said concavecontacting surface of said second piece is at least partially spherical.4. The medical device according to claim 1, wherein said first piececomprises a ball shaped piece and said second piece comprises a bowlshaped piece, and wherein said ball shaped piece is adapted to be placedin said bowl shaped piece to replace a functioning hip joint.
 5. Themedical device according to claim 4, wherein said ball shaped piece isadapted to be fixated in said bowl shaped piece using said releasingmember.
 6. The medical device according to claim 1, wherein saidreleasing member is adapted to non-invasively change from said firststate to said second state and from said second state to said firststate, when a predetermined strain is placed on said releasing member.7. The medical device according to claim 1, wherein at least one of saidfirst and second pieces comprises at least two parts adapted to be incontact with each other when the medical device is implanted in thepatient.
 8. The medical device according to claim 1, wherein said firstor said second piece is adapted to be introduced through a hole in thepelvic bone of the patient.
 9. The medical device according to claim 8,wherein one of said first and second piece are adapted to bemechanically fixated to each other after being introduced into the hipjoint through a hole in the pelvic bone of the patient.
 10. The medicaldevice according to claim 8, wherein said first or second piece isadapted to be introduced through a hole in the pelvic bone having across sectional area smaller than 530 mm².
 11. The medical deviceaccording to claim 8, wherein said first or second piece is adapted tobe introduced through a hole in the pelvic bone having a cross sectionalarea smaller than 380 mm².
 12. The medical device according to claim 8,wherein said first or second piece is adapted to be introduced through ahole in the pelvic bone having a cross sectional area smaller than 250mm².
 13. The medical device according to claim 8, wherein said first orsecond piece is adapted to be introduced through a hole in the pelvicbone having a cross sectional area smaller than 180 mm².
 14. The medicaldevice according to claim 8, wherein said first or second piece isadapted to be introduced through a hole in the pelvic bone having across sectional area smaller than 110 mm².
 15. The medical deviceaccording to claim 1, wherein said second piece of said medical devicecomprises said releasing member.
 16. The medical device according toclaim 15, wherein said releasing member comprises an elastic portion.17. The medical device according to claim 16, wherein said elasticportion comprises an elastic material.
 18. The medical device accordingto claim 16, wherein said elastic portion comprises a spring.
 19. Themedical device according to claim 16, wherein said elastic portioncomprises an elastic band.
 20. The medical device according to claim 19,wherein said elastic band is adapted to at least partly encircle saidball shaped piece. 21.-48. (canceled)